Ch. 5

Question 1

Purposes of infant feeding:

• Satisfies _________
• Provides ________ for growth and development
• Provides ______-_______ and _____-____ stimulation
• Facilitates state ______ and maintain homeostasis
• Provides ______ and sense of well-being
• Enhances _______ and interactions with ______
• Serves as _______ for other functions, including speech

Answer 1

• Satisfies hunger
• Provides nourishment for growth and development
• Provides oral-sensory and oral-motor stimulation
• Facilitates state regulation and maintain homeostasis
• Provides calming and sense of well-being
• Enhances bonding and interactions with caregiver
• Serves as foundation for other functions, including speech

Question 2

Oral anatomy of an infant is smaller and different than an adult:

• Oral cavity is _______ relative to _____ size.
• ______ pads (fat inside cheeks) are ______.
• There are no _______.
• Tongue rests _______ to alveolar ridge and contacts lower_______.
• Temporomandibular joint does not allow much ________ of jaw
• Oral anatomy is well suited for _______ (extension-retraction movements of the tongue).

Answer 2

Oral cavity is small relative to tongue size.
Buccal pads (fat inside cheeks) are large.
There are no teeth.
Tongue rests anterior to alveolar ridge and contacts lower lip.
Temporomandibular joint does not allow much movement of jaw
Oral anatomy is well suited for suckling (extension-retraction movements of the tongue).

Question 3

Pharyngeal anatomy of an infant is smaller and different than that of an adult:

• Pharynx is ________.
• Tongue ______, soft palate, and ______ walls are in ______ approximation.
• Larynx is _________ the size of an adult’s and is ______ in the hypopharynx.
• High position of the infant larynx causes the _______ to pass superiorly to the free margin of the soft palate and project into the _______.

Answer 3

Pharynx is short.
Tongue base, soft palate, and pharyngeal walls are in close approximation.
Larynx is one-third the size of an adult’s and is high in the hypopharynx.
High position of the infant larynx causes the epiglottis to pass superiorly to the free margin of the soft palate and project into the nasopharynx.

Question 4

Anatomy relevant to infant feeding:
Pharyngeal anatomy is well suited for the _____-_____-_____ synchrony.
______, ______, _____relationship are ideal for the suck-swallow-breathe synchrony.

Answer 4

Pharyngeal anatomy is well suited for the suck-swallow-breathe synchrony.
Head, chin, neck relationship are ideal for the suck-swallow-breathe synchrony.

Question 5

Oral Phase:

________ ______ and generation of negative ______ occur for sucking

Answer 5

nipple compression and generation of negative pressure occur for sucking

Question 6

Pharyngeal Phase:

_______, velum, and posterior pharyngeal provide driving force for _____ _______ to esophagus

Answer 6

tongue base, velum, and posterior pharyngeal provide driving force for bolus transfer to esophagus

Question 7

Esophageal Phase:

_____ _______ ______ opens for bolus transfer to _______; ______ ______ _____ opens to allow bolus entrance into ______

Answer 7

upper esophageal sphincter opens for bolus transfer to esophagus; lower esophageal sphincter opens to allow bolus entrance into stomach

Question 8

Coordination of _____, ______, ______ is crucial to prevent _______.
Suck-swallow-breathe ratio during is generally ______ or _______.
Decreased _______ during feeding may be a problem for some medically compromised infants.

Answer 8

Coordination of sucking, swallowing, and breathing is crucial to prevent aspiration (entry of material into the airway).
Suck-swallow-breathe ratio during is generally 1:1:1 or 2:1:1.
Decreased ventilation during feeding may be a problem for some medically compromised infants.

Question 9

Significant _____, _____, _____ growth takes place in the first 2 to 3 years of life.
Oral cavity becomes ________ with mandibular growth.
Tongue tip moves _____ _______ alveolar ridge.
Teeth _______.
Pharynx ________.
Neuromuscular, particularly ________ function matures.
Growth and maturation lead to changes in ________ ___________pattern.

Answer 9

Significant oral, pharyngeal, and laryngeal growth takes place in the first 2 to 3 years of life.
Oral cavity becomes larger with mandibular growth.
Tongue tip moves back to under alveolar ridge.
Teeth erupt.
Pharynx elongates.
Neuromuscular, particularly oral-motor function matures.
Growth and maturation lead to changes in feeding and swallowing pattern.

Question 10

Cleft Lip and Alveolus only:

• Infant may have initial problems achieving an adequate _____ ______ on the nipple.
• Inadequate lip seal may cause difficulty generating ______ _______ for sucking.

Answer 10

Infant may have initial problems achieving an adequate lip seal on the nipple.
Inadequate lip seal may cause difficulty generating negative pressure for sucking.

Question 11

Cleft Palate Only:

• Depends on the extent of the cleft
• Infant may be unable to generate ______ _______ for suction.
• Infant may be unable to find a hard palatal surface for ______ of the nipple.
• Infant may experience ______ _________.

Answer 11

Depends on the extent of the cleft
Infant may be unable to generate negative pressure for suction.
Infant may be unable to find a hard palatal surface for compression of the nipple.
Infant may experience nasal regurgitation.

Question 12

Cleft lip and palate:
-Infant may have all the difficulties noted above (lip and alveolus only, palate only), including these:
Difficulty achieving an adequate _____ ______ on the nipple
Inability to generate _____ _______ for suction
Inability to find _____ ______ for compression of the nipple
Nasal _______

Answer 12

Infant may have all the difficulties noted above, including these:
Difficulty achieving an adequate lip seal on the nipple
Inability to generate negative pressure for suction
Inability to find palatal surface for compression of the nipple
Nasal regurgitation

Question 13

Postoperative recommendations vary among centers:

• Some _______ sucking following surgery and may may recommend the use of ______ or _______ instead.
• Some recommend supplemental _____ _______ for a short time.
• Some allow ______ feeding after surgery.

Answer 13

Postoperative recommendations vary among centers:

• Some discourage sucking following surgery and may may recommend the use of cup or spoon instead.
• Some recommend supplemental tube feeding for a short time.
• Some allow unrestricted feeding after surgery.

Question 14

Anomalies that can contribute to a feeding or swallowing problem:
  \_\_\_\_\_\_\_\_\_ (small mandible)
  \_\_\_\_\_\_\_\_\_ (large tongue)
  \_\_\_\_\_\_\_\_\_ stenosis (narrowing)
  \_\_\_\_\_\_\_\_\_ anomalies
  \_\_\_\_\_\_\_\_\_ cleft 
  \_\_\_\_\_\_\_\_\_\_\_\_\_ fistula
  \_\_\_\_\_\_\_\_ or cranial nerve involvement
  \_\_\_\_\_\_\_ (posterior displacement of the tongue in the pharynx)
  Midface \_\_\_\_\_\_\_
  \_\_\_\_\_\_ \_\_\_\_\_\_\_\_ or lung disease
  \_\_\_\_\_\_\_ atresia

Answer 14

Anomalies that can contribute to a feeding or swallowing problem:
  Micrognathia (small mandible)
  Macroglossia (large tongue)
  Pharyngeal stenosis (narrowing)
  Vascular anomalies
  Laryngeal cleft 
  Tracheoesophageal fistula
  Cortical or cranial nerve involvement
  Glossoptosis (posterior displacement of the tongue in the pharynx)
  Midface retrusion
  Congenital heart or lung disease
  Choanal atresia

Question 15

Conditions that often affect feeding and swallowing include the following:
________ __________ sequence
____________ syndrome
____________ microsomia

Answer 15

Conditions that often affect feeding and swallowing include the following:
Pierre Robin sequence
Moebius syndrome
Hemifacial microsomia

Question 16

Most infants with a cleft are able to feed with __________ ________________
Infant’s performance during the ______ feedings determines which _______ _______and technique will be best.

Answer 16

Most infants with a cleft are able to feed with simple modifications.
Infant’s performance during the initial feedings determines which feeding method and technique will be best.

Question 17

Breastfeeding trials should be __________.
With cleft lip, breastfeeding is usually not a ___________.
With cleft palate, it is very challenging due to difficulties with __________ and _______
Options with cleft palate include:
__________ nursing
Modified ________/_________
______________ breast milk should always be recommended if breastfeeding is not possible.

Answer 17

Breastfeeding trials should be supported.
With cleft lip, breastfeeding is usually not a problem.
With cleft palate, it is very challenging due to difficulties with compression and suction.
Options with cleft palate include:
Supplemental nursing
Modified nipples/bottles
Pumping breast milk should always be recommended if breastfeeding is not possible.

Question 18

Characteristics to consider when choosing a modified nipple

Answer 18

Pliability
  Shape
  Length
  Hole type
  Hole size

Question 19

Nipples:
\_\_\_\_\_\_\_\_\_\_\_ nipple
\_\_\_\_\_\_\_\_\_\_ nipple (as illustrated here)
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ Nipple
\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ nipple

Answer 19

Orthodontic nipple
Pigeon nipple (as illustrated here)
Ross® Premature Nipple
Standard traditional nipple

Question 20

Specialized dipole and bottle systems:
_________ __________ Cleft Lip/Palate Nurser
____________ Cleft Palate Nurser
______________Feeder® (formerly the Haberman® Feeder)
__________ ___________ Feeder and Bottle

Answer 20

Mead JohnsonTM Cleft Lip/Palate Nurser
Ross® Cleft Palate Nurser
SpecialNeeds Feeder® (formerly the Haberman® Feeder)
Medela® SoftCup Feeder and Bottle

Table 5.1

Question 21

Mead Johnson:
Bottle and nipple _______, but can use any nipple with ____________
__________, long, & ________ nipple
_____________ nipple
__________ of bottle allows assistive squeeze to increase flow
Ability to monitor size of ______ being delivered by squeeze is _________

Answer 21

Bottle and nipple unit, but can use any nipple with bottle
Straight, long, & firm nipple
Crosscut nipple
Pliability of bottle allows assistive squeeze to increase flow
Ability to monitor size of bolus being delivered by squeeze is poor

Question 22

SpecialNeeds Feeder:
This bottle/nipple unit is relatively ________
It has a ________, moderate length, ____ nipple
It delivers fluid by _________ of nipple alone.
_______ ______ opening allows for adjustment of flow to _______ rates.
___________ valve decreases air intake.
Consider parent’s _______.

Answer 22

This bottle/nipple unit is relatively expensive.
It has a straight, moderate length, soft nipple
It delivers fluid by compression of nipple alone.
Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake.
Consider parent’s skills.

Question 23

Medela SoftCup System:
_______/_______ unit
Used for infants that cannot tolerate________ placement of nipple
Allows _______ of liquid in _______ amounts

Answer 23

Bottle/soft cup unit
Used for infants that cannot tolerate intraoral placement of nipple
Allows presentation of liquid in measured amounts

Question 24

Angled Neck Bottle:
Helpful when positioning has to be very __________
Allows for _______ flow of milk without forcing baby to adapt extended _______ position

Answer 24

Helpful when positioning has to be very upright

Allows for downward flow of milk without forcing baby to adapt extended head-neck position

Question 25

Pigeon Nipple and Bottle: - Nipple is ______________, with one thin side and one thicker side. - _________ side is for positioning against infant tongue to extract liquid flow with compression. - The Pigeon nipple is ________ (wider). - ________________ allows for flow into nipple with no back flow. - Bottle is ________ to allow for assistive squeezing. - Flow rate can be adjusted with _________ of collar on bottle.

Answer 25

Nipple is “Y” crosscut, with one thin side and one thicker side. Thinner side is for positioning against infant tongue to extract liquid flow with compression. The Pigeon nipple is larger (wider). One-way valve allows for flow into nipple with no back flow. Bottle is pliable to allow for assistive squeezing. Flow rate can be adjusted with tightness of collar on bottle.

Question 26

``` Positioning the Infant: ____________ (at least 60º) is best. Facilitates control of _____, ______, ______, ______ movements Allows ______ to assist with swallowing Helps prevent _____ _________ ```

Answer 26

Semi-upright (at least 60º) is best. Facilitates control of jaw, cheek, lip, and tongue movements Allows gravity to assist with swallowing Helps prevent nasal regurgitation

Question 27

Positioning the Nipple: | Place nipple ______ _______ bone to aid nipple compression

Answer 27

Place nipple under palatal bone to aid nipple compression

Question 28

Pacing Intake: | Fluid must be provided in ______ with the infant’s sucking compressions.

Answer 28

Fluid must be provided in rhythm with the infant’s sucking compressions.

Question 29

Feeder should _____ pace when there are signs of stress: Eye ______ or changes in facial expression Decreased ________ ________ of feeding _______ or ________ Signs of _______ air intake Signs of ______

Answer 29

Feeder should modify pace when there are signs of stress: Eye widening or changes in facial expression Decreased alertness Avoidance of feeding Coughing or choking Signs of excessive air intake Signs of fatigue

Question 30

Flow can be regulated by: _______ nipple slightly _________ Partially ________ the nipple from the oral cavity

Answer 30

Flow can be regulated by: Tilting nipple slightly upwards Partially removing the nipple from the oral cavity

Question 31

Oral Facilitation Strategies: Includes _____ and _____ support

Answer 31

Includes jaw and cheek support

Question 32

Preventing Excessive Air Intake: Increase the ______ of burping. Burp infant at least _____ every ______.

Answer 32

Increase the frequency of burping. | Burp infant at least once every ounce.

Question 33

Managing Nasal Regurgitation: Feeder should: Allow infant time to ______ or ______ to clear the nasal passage. Ensure that the infant is in an ______ position. Use a ______ flow nipple or ____ the pace.

Answer 33

Feeder should: Allow infant time to cough or sneeze to clear the nasal passage. Ensure that the infant is in an upright position. Use a slower flow nipple or slow the pace.

Question 34

Consitency of Feeding Methods: | Infant should be fed in the ______ _____, with the same _____ and ______, and same ______ during each feeding.

Answer 34

Infant should be fed in the same position, with the same nipple and bottle, and same technique during each feeding.

Question 35

Feeding obturator—a ______ _______ which can be used in first few _____ to assist infant with _____ _____ in feeding

Answer 35

Feeding obturator—a prosthetic appliance which can be used in first few months to assist infant with cleft palate in feeding

Question 36

Use of Feeding Obturators: Advantages: Keeps the _____ from resting ______ the cleft Provides a _____ _____ so tongue can achieve _____ of the nipple against it

Answer 36

Advantages: Keeps the tongue from resting inside the cleft Provides a solid surface so tongue can achieve compression of the nipple against it

Question 37

Use of Feeding Obturators: Most _______ centers no longer use feeding obturators, as they feel they are _________. Most infants with cleft feed well with _________.

Answer 37

Most craniofacial centers no longer use feeding obturators, as they feel they are unnecessary. Most infants with cleft feed well with modifications.

Question 38

Oral Hygiene - Mouths of infants are essentially _____ _____. - Infants with clefts have _____ in cleft area and nose, which can cause ______. - Caregiver should ______ the cleft and surrounding areas after______ with a washcloth, gauze, or Toothette®.

Answer 38

Mouths of infants are essentially self-cleaning. Infants with clefts have fluids in cleft area and nose, which can cause infection. Caregiver should cleanse the cleft and surrounding areas after feedings with a washcloth, gauze, or Toothette®.

Question 39

Transitioning to a cup: Consider when transitioning to a cup is __________ appropriate (usually between 6 and 9 months). The ___________ feeder can help with transition. Most surgeons recommend ______ from bottle prior to palate surgery because nipple in the mouth and ______ could cause ______ of repair

Answer 39

Consider when transitioning to a cup is developmentally appropriate (usually between 6 and 9 months). The Medela SoftCup™ feeder can help with transition. Most surgeons recommend weaning from bottle prior to palate surgery because nipple in the mouth and sucking could cause breakdown of repair

Question 40

Introduction of solid foods: Usually begun around _______ months, with rice cereals and ______ foods Assist in transition by using appropriate _______, small ______, slow _____, alternating with liquid to assist with ______. Rapid spoon-feeding or large spoonfuls can cause more frequent ____________ and disorganized swallowing.

Answer 40

Usually begun around 4 to 6 months, with rice cereals and strained foods Assist in transition by using appropriate positioning, small boluses, slow pace, alternating with liquid to assist with clearance. Rapid spoon-feeding or large spoonfuls can cause more frequent nasal regulation and disorganized swallowing.

Question 41

Assessment and Management of complex feeding problems: _____ __________ ________________ Swallowing Studies (VFSS) ____________ ___________Evaluation of Swallowing (FEES)

Answer 41

Clinical assessment Videofluoroscopic Swallowing Studies (VFSS) Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Question 42

Clinical Assessment: Should be performed by a ______ ________ (qualified SLP or OT) Assesses infant’s ability to _______ feed Determines effect of ___________ strategies on feeding performance

Answer 42

Should be performed by a feeding specialist (qualified SLP or OT) Assesses infant’s ability to safely feed Determines effect of compensatory strategies on feeding performance

Question 43

VFSS: Also called _______ __________ _______ Performed by a ______ and a speech-language pathologist Allows visualization of _______, ________, _________ phases of swallowing Can observe ________, response to aspiration, nasopharyngeal reflux, and effect of _______ strategies

Answer 43

Also called modified barium swallow Performed by a radiologist and a speech-language pathologist Allows visualization of oral, pharyngeal, and esophageal phases of swallowing Can observe aspiration, response to aspiration, nasopharyngeal reflux, and effect of compensatory strategies

Question 44

FEES Involves the _______ passage of an endoscope for viewing of the pharyngeal and laryngeal structures Allows assessment of _____ _______ during swallowing Provides information regarding sensory threshold in the ______ and ______ Can clearly view structures and management of _______ Disadvantage is temporary _____ of ______ when ______ ______ closes during the swallow

Answer 44

Involves the transnasal passage of an endoscope for viewing of the pharyngeal and laryngeal structures Allows assessment of airway protection during swallowing Provides information regarding sensory threshold in the pharynx and larynx Can clearly view structures and management of secretions Disadvantage is temporary loss of view when VP valve closes during the swallow

Question 45

Feeding team may include the following members:

Answer 45

``` Feeding team may include the following members: Gastroenterologist Nutritionist Nurse Speech-language pathologist Occupational therapist Behavioral psychologist Otolaryngologist Pulmonologist Consulting radiologist ```

Question 46

Alternative Feeding Methods for severe cases: Orogastric or __________ (NG) tube—for _______ feeding ________ (G) tube—for infants with _______ oral reflexes or poor ________ ________ while swallowing

Answer 46

Orogastric or nasogastric (NG) tube—for supplemental feeding Gastrostomy (G) tube—for infants with abnormal oral reflexes or poor airway protection while swallowing

Question 47

Ultimate goals of the feeding method are to provide: Adequate _______ and weight ______ _______ _______ for infant and caregiver Enhancement of __________ process Sensorimotor ________ for normal development

Answer 47

Ultimate goals of the feeding method are to provide: Adequate nutrition and weight gain Pleasurable experiences for infant and caregiver Enhancement of bonding process Sensorimotor stimulation for normal development